食管胃交界部癌外科治疗中淋巴结清扫的范围和价值

摘要

Objective: We studied the extent and value of the lymphadenectomy in surgical treatment of carcinoma of gastro-esophageal junction (GEJ). Methods: 217 patients with GEJ who underwent surgical resection were retrospectively analyzed.The extent of lymphadenectomy was divided into 5 types (DO to D4) and the curability of operation was graded as A, B and C. Results: The patients had been treated as follows: 186 with proximal gastrectomy, 31 with total gastrectomy, 97 with a combined- visceral resection. The patients who underwent D1, D2 and D3 lymphadenectomy were respectively 158, 58 and 1. The patients who were performed with resection of grade A, B and C were 53, 107 and 57 respectively. All patients were performed with a lymphadenectomy and well registered. The lymph node metastasis occurred in 157 cases (72.4%). The lymph node metastasis rate in the group 1, 2, 3, 4, 7, 9, 12 and 110 as well as in the pulmonary ligament group were higher than other groups. 2668 lymph nodes were removed, in which 655 (22.8%) demonstrated the existence of metastasis. The total lymph node metastatic degree in these groups was higher compared to the other groups. Conclusion: The survival rate in the D1 lymphadenectomy and D2 is similar for all patients, and there 5 be some differences in the 2nd and 3rd years for the D1 lymphadenectomy and D2 in the stage-IIIb patients. The survival rate of D2 lymphadenectomy in stage Illb is better than D1 and that of D2 lymphadenectomy is superior to D1 in stage-Ⅳ patients. The survival rate of grade A and B operation is much better than grade C, and the survival rate of grade A is also higher than B.